Human Resources Committee on Nov. 1st, 2011

[Dr. Ivy Lynn Bourgeault]

I think all four countries fail in terms of health human resources. I think that the tool three of those four countries, not Canada, have put in place has been a coordinated observatory, Health Workforce Australia, Health Workforce New Zealand, Centre for Workforce Intelligence in England. They are trying to coordinate this.

To answer the question you were talking about before, do we have enough doctors, I think the better way to answer that, or a different way to ask that, is what should doctors be doing? Where should they be practising? Should they be working at the top of their skill level, as well as the nurses, nurse practitioners, working at the top of their skill level?

We have written in legislation scopes of practice, and often these health care professionals are not working to their full scope of practice. If we did that through a variety of different incentives and coordinated policies, then I think we would have less of a shortage.

I also do want to caution that there has been a ramping up of the numbers in medical schools. If we looked at some of the other countries, like Australia and the U.K., they ramped up medical education. They will have quite a few of their graduates. They're looking at--and they were talking about it last week--unemployment amongst physicians in the U.K. and a possible situation of unemployment in Australia. They've ramped up much greater than we have.

I think you have to think about the health human resources as a system. It isn't just physicians and it isn't just nurses; it's the whole system together. Who should be doing what? They're doing fascinating things in New Zealand, having pharmacists manage certain prescriptions--because we're moving into a system of managing chronic diseases. Who is the best person to do what? I think that's the kind of question we need to ask, rather than do we have enough numbers. We seem to always be focused on numbers rather than on what they should be doing, where, and how.

[The Chair, Conservative, Ed Komarnicki]

Thank you, Ms. Bourgeault. That concludes your time.

Ms. Crowder.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

I do have a question. I just saw that Mr. Padmos had his hand up. I wonder if he wanted to add to that.

[Dr. Andrew Padmos]

I was just going to say that half of the patients I see in a general hematology clinic would not need to come to a general hematology clinic but could be seen in a family physician's office. The reason they don't is either uncertainty on the part of the physician or because our payment system, where you pay people to be pushed through a primary care system, encourages referral of anything that's out of the ordinary or at all difficult.

Rather than taking the time, they flip them off, and they wait three, six or nine months often to see someone like me in a specialist clinic.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Ms. Bourgeault and Dr. Padmos, you have both addressed a very critical issue in terms of the whole planning for health human resources in Canada. Again, in my view, we need a national strategy around the human resources. We're not talking about health care delivery, because that's clearly a provincial responsibility, but in terms of national leadership about health human resources....

Both of you have identified a couple of problems. Dr. Padmos, I heard you say that doctors are doing things they shouldn't be doing. We've got this problem with medical school graduates and whether there are placements for them, and we've got Canadians who are foreign-trained physicians coming back to Canada and they can't get residencies. These are people working in the highest and best practice.

If you were going to make one key recommendation to this committee around a health human resources strategy, what would it be?

[Dr. Andrew Padmos]

I think we should fund the observatory or research unit that Dr. Bourgeault has described.

[Dr. Ivy Lynn Bourgeault]

I would echo that.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Along with the funding, what are one or two key first steps that need to happen with this?

[Dr. Ivy Lynn Bourgeault]

You have so many different organizations in the health human resources field. You have an organization, the Canadian Institute of Health Information. It's an absolutely fantastic, internationally recognized organization collecting statistics, but those statistics aren't feeding into an advisory process.

You have the Advisory Committee on Health Delivery and Human Resources, which doesn't as a rule consult with the kinds of stakeholder organizations that you're consulting with on a regular basis.

The thing you have to realize is that the system of health human resources, the health care division of labour, is a complex adaptive system. You pull one policy lever and something will happen here. You have to have an organization whose full-time job is to watch that and to monitor it, and to have policies that respond when things are starting to go awry.

Sometimes you may have this amazing technological change that will mean, oh, we don't need any more of this kind, or we need less, or we need them over here. So having an organization like the pan-Canadian health human resources observatory allows you to do that. Again, it's not rocket science. It's being done with incredibly good results in Australia, New Zealand, and England.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

So there are three good examples of where it's working.

[Dr. Ivy Lynn Bourgeault]

Health Workforce Australia, Health Workforce New Zealand, the Centre for Workforce Intelligence in the U.K., and there's also an organization that's much smaller in the United States. But I think those other three organizations are much more applicable because of our public health care system.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Dr. Padmos, did you want to add something to that?

[Dr. Andrew Padmos]

No.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

What gets in the way? I was the health critic for the NDP back in 2004-05. This is not a new conversation, and there are many, many, many people out there who have written books and studies and whatnot to talk about what we need to do with health human resources in Canada. Yet we don't seem to be able to come to grips with it.

Dr. Bourgeault.

[Dr. Ivy Lynn Bourgeault]

We have some of the best researchers in health human resources here in Canada, and that's recognized in those other countries. But they have created an organization that really capitalizes on their research expertise and their knowledge. The research expertise is not just in the universities; it's in the stakeholder organizations as well.

The thing is that there's this allergic reaction to doing any centralized planning around health care delivery, because yes, it is a provincial jurisdiction.

But just getting back to the comment before about the $75 million that was provided to instigate some initiatives around internationally educated health professionals, the provincial stakeholders said without that money we would not have been able to do these things that we're doing.

I think there is an appetite to have a better coordinated response, because you have one province stealing from another province. So there's interprovincial jurisdiction or competition as much as there is international recruitment. I think someone just has to take the bull by the horns and do this.

[The Chair, Conservative, Ed Komarnicki]

Thank you for that point and suggestion.

Your time is obviously up, and given that the bells are ringing, it may be a good time for us to adjourn.

Thank you for your presentation and for your recommendations.

The meeting is adjourned.